| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE SUITE 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | $129 | $12K | 4.09% |
| USI INSURANCE SERVICES LLC3 | 308 NORTH 21ST STREET ST LOUIS, MO 63103 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 2.19% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC. | 312 ELM STREET FLOOR 24 CINCINNATI, OH 45202 | DELTA DENTAL OF KENTUCKY | $18K | — | $18K | 7.95% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE SUITE 350 VALHALL, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $21 | $3K | 6.72% |
| USI INSURANCE SERVICES LLC3 | 308 NORTH 21ST STREET ST LOUIS, MO 63103 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 3.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF KENTUCKY INC EIN 61-1237516 PBM | Float revenue; Claims processing; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | $282K |
| EXPRESS SCRIPTS, INC. | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $82K |
| USI MIDWEST LLC | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | — | $23K |
| USI INS SERVICES LLC | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $5K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 379 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 379 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF KENTUCKY | 782 | $227K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 278 | $41K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 447 | $302K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 447 | $302K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 447 | $302K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 869 | $159K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 447 | $302K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 869 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.